used to determine the direct and indirect effects of latent constructs, such as discrimination, racism, self-esteem, locus of control, cultural identity, and racial socialization.

Instruments need to be developed that can adequately measure perceptions of racism and discrimination in different age groups (from young children to adults) and different ethnicities. Such instruments should be tested for conceptual and measurement equivalency across ethnic and age groups within each group. Ultimately, large-scale national surveys such as the Health Interview Survey, NHANES, and National Longitudinal Survey of Youth should incorporate measures of racism and discrimination, whether limited to a single question or full instruments. One approach may be to create instruments that have a core set of generic items or subscales that are appropriate to measure racial discrimination among all minority groups, as well as additional items or questions salient to each particular ethnic minority group to ensure emic validity. Such instruments could potentially be used in comparative studies of the effects of discrimination among different groups as well in studies addressing the specific dimensions of discrimination salient within each group.

The development of such instruments is likely to require the use of both qualitative and quantitative methodologies, from ethnography and focus groups to confirmatory factor analysis and Rasch modeling. The utilization of multidisciplinary research teams, which include representation from such fields as public health, clinical health research, pediatrics, child development, education, anthropology, sociology, and psychometrics, would help to create instruments that are theoretically driven, conceptually valid, and psychometrically sound. Although not specific to children or to health, a recent National Research Council report (2004) outlines a series of recommendations related to measurement of discrimination.

SERVICES

Evaluating the effect of services on children’s health is an important consideration both in terms of understanding the relative role of various influences on health and in relation to public policy decisions regarding services expenditures. In 2000, federal spending on children under age 18 was estimated to be $25 billion on Medicaid and the State Child Health Insurance Program (SCHIP) and approximately $123 billion on a wide range of other services, including food stamps, nutrition programs, social services, and other health and human development programs (http://www.cbo.gov/showdoc.cfm?index=2300&sequence=0). These federal expenditures do not include additional spending by state and local governments directed at promoting the health of children or improving their neighborhoods, or expenditures by their parents, families, or their parent’s employers. From the standpoint of federal, state, and local policy, decision makers need to



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